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First Online PA Program

By now you’ve surely heard of the first Physician Assistant, excuse me, Physician Associate program wanting to go “live”. What I mean by this is a fully incorporated didactic online program in medicine resulting in the completion of a master's degree without any prior PA training (no certificate, associate’s or bachelor’s degree in PA studies). Yale first announced this news on March 10th, 2015 and while it has had mixed feelings from across the PA and physician community, technology is changing, education is changing, and the realm of the physician assistant must change too. In this article I will brief you on the background of the program and hopefully provide an unbiased approach to online physician assistant programs.

The introduction of Yale School of Medicine's online Physician Associate program has definitely stirred about much debate. Schools like Yale have an outstanding reputation of graduating highly skilled and well-trained physician associates/assistants, but in April of 2015 ARC-PA did approve their initial proposal, as an increase in class size was necessary. Van Rhee, Yale’s director, claimed ARC-PA policy said that they “will not consider a new request for an increase in class size from a program until 4 years after the program’s most recent submission and approval for a class size increase.” Dean Alpern of Yale claimed that the proposal was denied because ARC-PA believed the program would not be similar enough to Yale’s current PA program to be considered class size expansion. Whatever the cause, Yale has proposed to apply as a new PA program separate from the currently accredited program using the provisional accreditation process. Van Rhee claims that this process will take approximately 1.5 years from April 2015. This is exactly what they propose to do in the near future.

Yale’s program is intended to be a blend of online courses and clinical clerkships, helping to meet the demands of PAs in primary care and underserved areas all over the U.S by matching the size of it’s current program in its first year (12 students beginning at 3 separate times each year). The program plans to expand to approximately 350 students within 5+ years and plans to work with an online education company called 2U. Requirements for admission to the program would be the same as those currently required at Yale’s prestigious PA program. This is contrary to popular belief that students admitted to this program would somehow be less qualified. Clinical sites would be selected by the program faculty with specificity to each student’s location and career goals, maintaining a very student-specific agenda. Tuition costs to each matriculant of the program would be the same as those to the current Yale PA Program, approximately $87,330. This has also stirred about much debate, as Yale may have a financial hidden agenda to starting such a program. Opponents of the program, namely alumni of the PA program, are upset about a lack of transparency and being caught off-guard with how rapidly the school planned to implement such a program. They also claim that it would devalue their own degree, as the program’s would be entirely different.

Other programs, such as the University of Wisconsin, offer ‘distance’ or online (part-time) programs with recorded web-based didactic lectures and clinical rotations in your surrounding community and another program called ‘wisPACT’ that offers live real-time online (full-time) lectures with clinical rotations in or around the school. In both programs, students meet in Madison for the first summer of the program for 2-4 days. The first program is completed in approximately 36 months and the latter, 24 months. Labs must be conducted through UW-Madison PA faculty at partnering hospitals and clinics in Wausau, WI, twice per semester. More information is available on their site, but other online PA programs’ should not go unnoticed or be under any less scrutiny than Yale.

While I do not sanction online physician assistant training, I realize that times are changing, and even our program uses podcasts and online resources as variations in teaching methods. Without them, we would be lost in this advancing digital world. Hell - look at our CME credits! Half or more of that is online nowadays!

Concerns brought about by members of the PA community (i.e. Cons to starting an online PA program): Please realize these are mostly opinions and are summarized here for your own advantage.

Damage the credibility of the reputation itself by not being well-accepted publicly

Decrease the reputation of upstanding and rigorous PA programs nationwide

Create clinical site competition between PA programs around the U.S.

Programs will not be able to guarantee clinical sites in your area and students will have to provide costs for travel and lodging in areas where sites are available.

The creation of newer, less well-designed online PA programs will ensue (University of Phoenix, Kaplan, etc.)

Medical training involves substantial patient interaction that should be developed in concert with coursework, not separately

Adequate preparation for clinical rotations will not be met with crash courses on campus, including anatomy, procedure workshops, H&P workshops and patient simulations

May compromise patient care quality due to online degrees not having significant foundation

Students do not reap benefits of on-campus life that shape medical providers (student clinics, supplemental courses, school organizations, leadership positions, special events, attending grand round lectures, networking or building professional relationships in-person, access to libraries or other on-campus resources

Clinical content may be ‘watered down’ and exams may be reused with the potential for more cheating to occur

Loss of camaraderie between students

The program may or may not be fully interactive, offering real-time access for questions and staff support

Medical schools are not following suit

An online degree will not be equivalent to other degrees  

Yale’s PA program is currently undergoing major curriculum changes and may have financial ties to starting a program of such size, including cheaper cost to educate students and more financial gain

Proponents of online PA programs (i.e. Pros to starting an online PA program): Please realize these are mostly opinions and are summarized here for your own advantage.

The number of available seats or space at PA programs has always been a limiting factor - online PA programs may alleviate this issue

Online programs bring a more self-directed learning approach to the profession, something we already implement in every PA program across the nation

PA students do not need a brick and mortar classroom to learn, they need quality lectures and expert opinion

Students will not be required to move away from their support systems and save money on living expenses

Common misconceptions about online PA programs: Please realize these are mostly opinions and are summarized here for your own advantage.

Programs like Yale will have contracts with clinical rotation sites, offering stipends for those who allow students time, expertise, and experience, rather than just shadowing. Yale will not and does not pay any clinical preceptors for their time. This policy will not change.

It degrades the profession. We must realize that this is an opinion, not a fact. Others in our profession argue that even if you complete the online program, you must pass the PANCe and employers won’t care where you got your degree because a PA-C is a PA-C.

Online PA programs will enroll less qualified applicants - Yale has made this abundantly clear that all applicants to either program will be judged according to prior standards, including appropriate didactic training and prior clinical training.

Online PA students will create clinical site competition between other PA programs near their hometowns. This is a false belief, as we can look at the numerous postgraduate online PA programs below and understand that many of these also have similar curriculum’s. If ‘x’ number of postgraduate physician assistants call fill spots in clinical sites to complete their master’s degree, then why couldn’t 350 students across the U.S.?

Adequate preparation for clinical rotations will not be met with crash courses on campus, including anatomy, procedure workshops, H&P workshops and patient simulations - Yale has provided on campus sessions where students will learn these skills in New Haven, CT. The current plan involves students performing a session at the beginning and end of didactic training, the end of the clinical years,  and an opportunity for students to elect for rotations at Yale, if desired.

The increase in online PA students will saturate the market. This is an obvious misconception. If you are worried that 350 students from an online PA program are going to ‘saturate’ your job market, you should be more concerned about the 80+ PA programs that are non-web based with provisional accreditation. In the next few years, more PA programs plan to open up and with them, more PA students. Even so, the job market is only expected to grow.

If medical schools are not following suit, why should PA programs? The vast class size of 350+ students is daunting to someone who went to programs much smaller. There are PA programs upward in the 90’s and higher out there, but nothing of this magnitude. Keep in mind that most medical students are not required to even attend lecture and programs admit 200 or more students into each class. These students ‘stream’ their lectures from home or elsewhere without ever stepping foot into a classroom, unless for exams.

Class size of 350 is too high. Yale has stated that it will begin with 12 students that start at 3 separate times throughout the year. This doesn’t mean they’re going to go from 0 to 60 in 60 seconds. The approach of the number 350 may be 15-20 years away from when the program begins. This is all unanswered and biased information based on what ‘officials’ from the School of Medicine have stated. Ultimately, ARC-PA will regulate their numbers, so we really should allow them to do their job.  

How would students afford programs that cost $87,330 for tuition? This doesn’t seem cheap, but comparatively, students pay this and much more to go to out-of-state PA programs and programs in the northeast in general. There are many programs with similar tuition costs that does not even include the cost of living in an urban area. While I do not agree with keeping costs the same for an online program, this would nearly be unfair if traditional students were charged more for the ‘same’ education (from a material standpoint).  

Exams will not be proctored, making knowledge checking avoidable. This is probably not the case, because many online programs in other fields have students attend a local university or testing site for proctoring.

While I must say, this is a dynamic shift in the non-traditional educational model, maybe we shouldn’t be so quick to judge. No one can truly foresee the impact or the quality of the program until it has begun and please realize that everyone in our PA community sees online education differently. Look at CAQ exams and PA residencies, which some PAs also opposed, yet they are still not the standard and are not as common as some might think. Some individuals are more opinionated than others about this issue, but our generation experiences an interactive multimedia education nearly everyday, with podcasts, powerpoints, recorded lectures, phone applications, e-mail, electronic health records, etc. This could very well be more effective than a powerpoint or blackboard lecture, anyday, despite what people who went to PA school 10-20 years ago say. Did they even have the Internet then? Just kidding. As another PA member put this - if done correctly, this program could have very positive outcomes, but until it proves itself, it will be under tons of scrutiny.

This may also be the bridge between those lectures you couldn’t stand, those that forced you to read the textbook, or worse, Up-to-Date. Thinking on my own didactic education and how many lectures I have listened to via podcast, it may not be such a bad idea if the lecturers were high quality and of expert opinion. Imagine if every lecture you had was perfect, just like the lectures you when told yourself “I wish there were more people who taught like them.” This could also be the bridge between increasing our own numbers as a profession, which we are so apt to do, as evidenced by the massive influx of accreditation-seeking PA programs. Economically, this type of education makes sense for those who may not want or simply cannot afford education in urban areas (due to living expenses) or wish to do their rotations in rural areas. There is a lot of unmet need, and PA education, in addition to physician and nursing educational models, must change with the times. Again, I am not an ambassador, nor do I endorse online PA programs, but my intention is for all to see both sides of the spectrum.

Looking at the percentage of newly graduated PAs of traditional programs that do not pass the PANCE, we can analyze that this newer non-traditional method of learning is being scrutinized from the ground up even though they have yet to put it into practice. Has anyone considered why our traditional model isn’t perfect and why PA students aren’t passing the PANCE at programs right now? The fact is that the ineffectiveness of our current system is going unnoticed and we are putting all of our attention on this shiny new object that no one wishes to welcome, yet no one stops to think about how traditional programs could be improved. Let’s be honest with ourselves - online PA education would not remove students from practicing and being tested over clinical skills or learning what heart or lung sounds-sound like. That can be studied from Bates or from YouTube videos, as we all have done at one time or another. As another put it, being successful as a PA lies with the individual and programs have the responsibility to foster and encourage this process, but it is not the model of learning that makes the PA. It is the desire, the ambition, and the will to become a better clinician, to learn medicine and become the best physician assistant you can to improve patient care quality.

The real challenge facing us is not online PA programs, however. Degree creep (the clinical doctoral PA degree), postgraduate education (residencies and fellowships), and advanced certification (Certificates of Added Qualification) are the true beasts. It is my belief that these ‘options’ will become more of ‘requirements’ in the near future, as employers will continue to expect more and more from new graduates and even seasoned PAs.

Postgraduate Online PA programs

Have your bachelor’s, associate’s or certificate in physician assistant studies? Need to obtain a master’s degree before 2020? Other PA programs, including A.T. Still University and Pace University, offer advanced physician assistant postgraduate programs to enhance, rather than replace the education already offered. For example, A.T. Still University offers physician assistants who have graduated prior to the new 2020 requirements of a master’s degree to pursue a Master of Science in Advanced PA Studies with a concentration in either Clinical Medicine or Education and Leadership.

Pace’s program is all online and can be completed in 4 semesters (1 year part-time study). The program is “highly competitive” and seeks students with prior clinical experience and appropriate didactic training. All courses and exams are completed online. The application is completed online.

Other similar online postgraduate PA programs include Drexel University, The University of Wisconsin-Madison, Touro College, and the University of Nebraska.

Non-online postgraduate PA programs: Stony Brook University, Georgia Regents University, Southern Illinois University, University of Detroit-Mercy,University of Washington, The University of Texas Medical Branch, and UT Pan American

Sources:

http://news.yale.edu/2015/03/10/yale-launch-its-first-national-online-pa-program

http://www.physicianassistantforum.com/index.php?/topic/17108-take-action-if-you-oppose-yales-online-pa-program/

http://www.buzzfeed.com/mollyhensleyclancy/yales-first-online-degree-gets-cheers-from-investors#.xtQKb3DgJ

http://www.physicianassistantforum.com/index.php?/topic/16900-online-pa-programs/page-3

http://www.theatlantic.com/education/archive/2015/03/learning-how-to-practice-medicinevirtually/388276/

http://www.physicianassistantforum.com/index.php?/topic/16900-online-pa-programs/page-4

http://www.physicianassistantforum.com/index.php?/topic/16900-online-pa-programs/page-5

http://www.arc-pa.org/documents/AccreditationActions2015M.pdf